How’s Your Digestion? Real Help for IBS from Dietitian Patsy Catsos

Right off the bat, let’s get one thing straight between us. Digestion is very important. Everybody eats, and digests food, and it’s nothing to be skittish about. Digestion is so central to your health and well-being that we can’t really afford to ignore it.

Especially when it’s not going well. For millions of people, it’s not going well.

For people with digestive issues, daily discomfort and symptoms can be crippling. For years, a visit to a doctor to seek help for things like chronic gas, bloating, diarrhea, constipation and the like has been a frustrating experience. Most doctors will tell patients that they have Irritable Bowel Syndrome, and offer very little help. The typical advice is to avoid alcohol, caffeine, chocolate, and stress. Maybe it’s dairy products, they say, and of course it may be hormonal. Each patient is left to try to figure out which foods make her symptoms worse, by experimentation.

But there is another way. At the 2013 IACP conference, I attended a seminar by Patsy Catsos on food issues, and I learned about a component in foods that just might be the source of much of this trouble.

According to Catsos, there is a whole other way of eating for IBS. The culprit, it seems is a component in foods that is called FODMAPS. This stands for Fermentable Oligo-Mono and Disaccharides and Polyols.

What the heck are those?

The key thing to understand is the fermentable part. For people with “normal” guts, eating foods that ferment in the digestive process is seen as good. Grains, beans, and lots of vegetables and fruits contain fermentable bits, and the good bacteria in the digestive tract flourish while breaking them down. But for the IBS sufferer, this process causes problems. I asked Catsos if we know why this happens to some people.

“We don’t fully understand why fermentable carbohydrates cause more trouble for some people than for others. It is beginning to look like the gut microbiome of people with IBS is different; their resident microbes might produce more or different types of gas.” said Catsos.

It seems that consuming FODMAPS has an “osmotic effect,” which means that as they are digested, the gut pulls in water from the body, with disastrous results. for IBS sufferers, this causes pain, bloating and diarrhea, or constipation. As gut bacteria consume the FODMAP sugars, they give off gases, also causing problems.

So, if you are one of the 20% of Americans with IBS, it might pay to find out more about FODMAPS. It’s also good to know that their effects are cumulative. Eating a little bit of one one day might be fine, but as they add up over the day, their effects become pronounced.

There are groups of foods that contain certain FODMAPS, and these are the main categories.

LACTOSE

Dairy products contain lactose, a common FODMAP.

FRUCTOSE

All fruits and vegetables and many natural sweeteners contain some fructose. But, IBS sufferers can usually do well with fruits that have a balance of fructose and glucose, and by keeping that cumulative effect in mind. High fructose to glucose fruits include apples, pears, stone fruits, watermelon and blackberries. Better choices are Strawberries, blueberries, cranberries, grapes, pineapple, cantaloupe, honeydew, kiwi, ripe bananas, and citrus. Honey and agave are high in fructose.

FRUCTANS

These are fermentable fibers found in wheat, whole grains, and in some fiber supplements. They are also in onions and garlic. For non-IBS people, they are great. For the IBS patient, they are not.

GALACTANS

Like fructans, these indigestible starches are a favorite of bacteria in the gut. They are in beans, pistachios and cashews.

POLYOLS

A naturally occurring sugar alcohol that is also used like an artificial sweetener in sugar-free foods. They are present in mushrooms, sweet corn, and stone fruits. Mannitol, sorbitol, xylitol, and other -ols are to be avoided, as they cause the “osmotic effect.”

In light of all the problems people are having these days figuring out their food allergies and intolerances, the FODMAP concept is worth learning about. I often meet people who are convinced that they are allergic to gluten or some other food, when they may be FODMAP sensitive. I asked Catsos if she saw this too.

“Yes. I try to get the word out on that as often as I can. I believe that many people who feel better on a “gluten-free” or a “dairy-free” diet are really feeling better because they are eating less FODMAPs. Avoiding all gluten and dairy is probably overkill for many of these folks. Extra dietary restriction make life more difficult and expensive, and make it more difficult to get the nutritional benefits of a varied diet. I work with people every week who are very excited to find out they can enjoy yogurt or bread again without pain.”

If giving up wheat gives you relief from digestive symptoms, it may well be the fructans, not the gluten. As much as I love to sing the praises of healthy foods like whole grains, beans, and onions, there are people out there who just can’t tolerate all that fermentation going on inside them.

In the end, most people with digestive sensitivites become their own food detectives. If you have these issues, keep a food journal, and see if you can find a pattern. A FODMAP elimination diet, in which you cut put all the food groups with the offending sugars for 2-3 weeks, may make you feel better. Then, Catsos says there is good reason to be hopeful.

“A low FODMAP diet is a temporary learning diet designed to help people work out which FODMAPs are bothering them. Most people should go on to liberalized their diets as much as they can tolerate. It often involves making more conscious decisions about portion sizes and the overall load of FODMAPs they consume at one time.

Occasionally FODMAP intolerance occurs after a stomach bug, or during a flare-up of Crohn’s or colitis, or due to un-diagnosed celiac disease. If the underlying condition improves, ability to tolerate FODMAPs might improve, too.”

And if you have been frustrated by your doctor’s lack of info on this issue, that is changing, too, according to Catsos.

“Drs. Peter Gibson and Susan Shepherd (from Australia) spoke at the 2011 American College of Gastroenterology Annual meeting. Since then, awareness of the diet has grown by leaps and bounds. It’s true, in the past doctors had very few effective treatment options to offer people with IBS, a situation I can assure you was very frustrating for everyone involved. Of course, doctors aren’t trained to guide patients through an elimination diet. They don’t have the time or inclination to talk about label reading, recipe modification and menu planning with their clients. Doctors are learning how to recognize good candidates for the diet, though, and hopefully will refer them directly to a registered dietitian.”

For more on Patsy Catsos MS, RD, LD, and info on her books, check out www.ibsfree.net